Aim
Patients and Methods
Study Design
Study Population
Variables Definition
Outcome Assessment
Statistical Analysis
Results
Demographics and Clinical Features
Variable | Definition | All patients (n = 102) |
---|---|---|
Age | 65 (32–84) years | |
≤ 65 years | 55 (53.9%) | |
> 65 years | 47 (46.1%) | |
Gender | Female | 56 (54.9%) |
Male | 46 (45.1%) | |
BMI | 25.3 (16.3–38.3) | |
Diabetes mellitus | Yes | 11 (11%) |
Other comorbidities | Yes | 26 (25.5%) |
Preoperative chemotherapy | Yes | 8 (7.9%) |
Tumor location in preoperative imaging | 1 = single lesion centrally located | 70 (72.2%) |
2 = multiple tumors located in right liver lobe requiring extended right hepatectomy | 18 (18.6%) | |
3 = Bilobular tumors requiring clearance of FLR and right or extended right hepatectomy | 9 (8.8%) | |
Surgical decision for ALPPS | 1 = neither volume nor function of FLR sufficient | 84 (86.6%) |
2 = volume sufficient but functional FLR insufficient | 5 (5.2%) | |
3 = not specified | 8 (8.2%) | |
FLR stage 1 (FLR1) | 336 (128–664) ml | |
FLR1/sTLV | 22% (9–39%) | |
FLR1/BW | 0.46% (0.19–0.84%) | |
FLR stage 2 | 611 (270–982) ml | |
FLR2/sTLV | 40% (16–69%) | |
FLR2/BW | 0.84% (0.35–1.51%) |
Procedure Details
Volumetry Study Outcome
Postoperative Morbidity and Mortality (Table 2)
Complications | Definition | Stage-1 (n = 102) | Stage-2 (n = 99) |
---|---|---|---|
Liver failure | No | 74/83 (89.2%) | 56/86 (65.1%) |
PHLF grade A | 6/83 (7.2%) | 9/86 (10.5%) | |
PHLF grade B | 3/83 (3.6%) | 10/86 (11.6%) | |
PHLF grade C | 0/83 (0%) | 11/86 (12.8%) | |
Ascites | No or less than 500 ml/day after POD 3 | 60/72 (83.3%) | 36/74 (48.7%) |
Grade A (over 500 ml/day) | 8/72 (11.1%) | 12/74 (16.2%) | |
Grade B (requiring diuretics and/or albumin but less than 1000 ml/day after POD 7) | 2/72 (2.8%) | 11/74 (14.8%) | |
Grade C (more than 1000 ml/day after POD 7) | 2/72 (2.8%) | 15/74 (20.3%) | |
Hemorrhage | No transfusion | 70/95 (73.7%) | 66/96 (68.7%) |
Grade A | 8/95 (8.4%) | 8/96 (8.3%) | |
Grade B | 2/95 (2.1%) | 7/96 (7.3%) | |
Grade C | 3/95 (3.2%) | 3/96 (3.1%) | |
Reported as hemorrhage but without further detail | 12/95 (12.6%) | 12/96 (12.6%) | |
Infection complication | No | 82/95 (86.3%) | 54/96 (56.2%) |
Grade A (Clavien-Dindo grade II) | 9/95 (9.5%) | 12/96 (12.5%) | |
Grade B (Clavien-Dindo grade IIIa) | 3/95 (3.2%) | 8/96 (8.3%) | |
Grade C (Clavien-Dindo grade IIIb and more) | 1/95 (1.0%) | 12/96 (12.5%) | |
Reported as infection but without further detail | 0 | 10/96 (10.5%) | |
Bile leaks | No | 83/95 (87.4%) | 67/97 (69.1%) |
Grade A | 9/95 (9.5%) | 6/97 (6.2%) | |
Grade B | 3/95 (3.2%) | 7/97 (7.2%) | |
Grade C | 0 | 7/97 (7.2%) | |
Reported as bile leak but without further detail | 0 | 10/97 (10.3%) |
Risk Factors for Severe Complications (Clavien-Dindo Grades 3b to 5)
Histopathological Results
Variable | Definition | Patients (n = 99) |
---|---|---|
Histology | Adenocarcinoma | 90/96 (93.7%) |
Other | 6/96 (6.3%) | |
Margin | Negative of tumor | 87/99 (87.9%) |
Positive of tumor | 12/99 (12.1%) | |
Grading | 1 | 7/87 (6.9%) |
2 | 52/87 (59.8%) | |
3 | 29/87 (33.3%) | |
Stage (AJCC 7th edition)* | I | 6/84 (7.1%) |
II | 33/84 (39.3%) | |
III | 10/84 (11.9%) | |
IVa | 35/84 (41.7%) | |
Primary tumor* | T1 | 13/93 (14%) |
T2 | 38/93 (40.9%) | |
T2a | 6/93 (6.4%) | |
T2b | 14/93 (15%) | |
T3 | 20/93 (21.5%) | |
T4 | 2/93 (2.2%) | |
Nodal status* | N0 | 59/94 (62.8%) |
N1 | 35/94 (37.2%) | |
Metastasis* | M0 | 94/94 (100%) |
M1 | 0 | |
Multifocal lesion | N | 55/91 (60.4%) |
Y | 36/91 (39.6%) | |
Number of lesions | 1 (1–6) | |
Largest tumor size (mm) | 85 (6–260) | |
Non-tumor Liver histology | Normal | 51/84 (60.7%) |
Fibrosis | 22/84 (26.2%) | |
Steatosis > 30% | 6/84 (7.1%) | |
CASH | 3/84 (3.6%) | |
Cirrhosis | 1/84 (2.4%) |
Follow-Up
Propensity Score Matching Analysis
Definition | CTx group (n = 88) | ALPPS group (n = 88) | p value | |
---|---|---|---|---|
Age | Continuous | 64 (36–85) | 65 (32–81) | 0.783 |
≤ 65 | 45 (51.1%) | 45 (51.1%) | 1.000 | |
> 65 | 43 (48.9%) | 43 (48.9%) | ||
Gender | Female | 51 (58%) | 51 (58%) | 1.000 |
Male | 37 (42%) | 37 (42%) | ||
Grade | G1 | 5 (8.8%) | 7 (8.5%) | 0.908 |
G2 | 32 (56.4%) | 49 (59.8%) | ||
G3 | 21 (35.1%) | 26 (31.7%) | ||
N.A. | 31 (35.2%) | 4 (5%) | ||
Stage* | I | 9 (10.2%) | 9 (10.2%) | 1.000 |
II | 34 (38.6%) | 34 (38.6%) | ||
III | 12 (13.6%) | 12 (13.6%) | ||
IVa | 33 (37.5%) | 33 (37.5%) | ||
T* | T1 | 12 (13.6%) | 12 (13.6%) | 0.973 |
T2 | 55 (62.5%) | 55 (62.5%) | ||
T3 | 18 (20.5%) | 19 (21.6%) | ||
T4 | 3 (3.4%) | 2 (2.3%) | ||
N* | N0 | 57 (64.8%) | 57 (64.8%) | 1.000 |
N1 | 31 (35.2%) | 31 (35.2%) | ||
M* | M0 | 88 (100%) | 88 (100%) | 1.000 |
M1 | 0–(0%) | 0–(0%) | ||
Tumor Size (mm) | Continuous | 75 (11–180) | 85 (6–260) | 0.204 |